Why Do Insurance Companies Not Pay for Cosmetic Plastic Surgery

January 7, 2011

Actually, the original question is much longer, and I’ll answer all of it. Here’s the original question-

“Explain why insurance companies do not pay for elective cosmetic plastic surgery and what have you done to help your patients understand. Would your answer be different if obama-care paid for this procedure?”

In general, your health insurance covers necessary things to maintain your life and longevity. Of course, what your health insurance pays for may differ from what you may consider is necessary. Cosmetic Plastic Surgery can be defined as a procedure that helps with your overall body aesthetics, but not necessarily your longevity or life. There are many exceptions, including breast reconstruction after breast cancer surgery, upper eyelid lift for excessive upper eyelid skin that inhibits vision, breast reduction for large breasts, and others.

However, even in fields outside of cosmetic surgery, health insurance does have it’s limits. For example, you may have vision insurance, but you may not be able to get the Oliver Peoples’ frames that you want. Your health insurance may pay for a hearing aid, but it may not pay for the best and most sophisticated one possible. Your health insurance may pay for chemotherapy costs, but may not pay for any cancer treatments that are considered too new or experimental.

The ASPS/ American Society of Plastic Surgeons has several great articles on health insurance and plastic surgery. The links are below.

Regarding my efforts, I try to explain to patients what is covered and not covered BEFORE any procedure is done. If need be, we get written documentation from the health insurance company explicitly stating what is to be covered, or not, so that there are no surprises.

I don’t think my answer would be different if Obamacare paid for these procedures. In general, the Federal Government and HHS/ Health and Human Services has already had guideline and rulings on what is or is not covered by Medicare and Medicaid. To my knowledge, the Obamacare law hasn’t really affected cosmetic plastic surgery guidelines.

Thanks for the great questions, and I hope this answers them! If not, please send me a comment or question.